Jones & Bartlett Publishers: 13-Feb-02
February 2002
Welcome to Jones and Bartlett's Emergency Care Electronic Newsletter. This monthly newsletter is designed exclusively for our community of instructors. Please see the end of this message for information on subscribing or unsubscribing.
TABLE OF CONTENTS
1. INTERESTING NEWS STORIES
2. MEDICAL JOURNAL REVIEWS
3. TEACHING TIP
4. ON-LINE SITES
5. FIRST AID DIGEST
6. WHAT'S NEW?
7. CALENDAR
1. INTERESTING NEWS STORIES
Salt Lake City, UT - A paraglider became caught in power lines sustained second-degree burns. Utah Power and Light cut power to the 138,000-volt line for the rescue effort, creating a power outage for about 30,000 customers. The paraglider is in critical condition.
Boone, NC - A 48-year-old skier was fatally injured when he lost control and tumbled into a rocky embankment. He was treated for head injuries by the ski patrol and died later at a clinic.
Park City, UT - A 4-year-old boy wandered away from a baby sitter to a small partially frozen lake. Two workmen saw the boy's head bobbing up and down in the water. One workman laid down to distribute his weight evenly on the thin ice and successfully rescued the boy.
2. MEDICAL JOURNAL REVIEWS
Asthma
The researchers studied whether men and women report the same severity of asthma symptoms for similar levels of airway obstruction. Previous asthma patient studies have demonstrated that women are more frequently admitted to the hospital and have longer hospital stays than men. The researchers found 1,291 patients with moderate to severe asthma. Of these, 62% were women. Women proved more likely than men to report severe complaints. The researchers concluded that women more frequently describe severe symptoms and activity restrictions than men, despite having similar levels of asthma.
Source: Annals of Emergency Medicine 38:123-128, 2001
Health Risks Related to Bathing in Seawater
This study attempted to define the relationship between pollution and adverse reactions in swimmers. 1,805 swimmers were randomly interviewed at four beaches just north of Spain. When coliforms in the water increased, so did the complaints of both gastrointestinal symptoms and skin symptoms. Also, as the total of fecal streptococci in the water increased, so did the number of complaints of GI symptoms. For the most part, this study supports data from similar studies--polluted water can cause harmful effects to humans.
Source: Journal of Epidemiology and Community Health, 55:442-447, 2001.
Refusal of Care
The researchers analyzed data from 147 patients over a six-month period. Each of these patients had initially refused transport. Of the 147 patients, 18 were intoxicated and 30 had altered mental status. Of these 147, EMS eventually transported 37 patients. Three of these 37 were transported against their wishes (with the help of law enforcement when the patient was deemed incapacitated). Intoxicated patients and altered mental status patients agreed to be transported more often than their sober and/or alert counterparts. It was found that physician-to-patient communication resulted in some patients agreeing to care.
Source: Academic Emergency Medicine 8:725-730, 2001.
3. TEACHING TIP
Storytelling
At the end of the first class, notify students that they will have to tell a family first aid story sometime during the duration of the course. After they have had time to recall such a story, have them "sign-up" for a topic in which the story fits. Family stories are about one to three minutes in length and illustrate a particular type of injury which occurred to a family member. Life experiences can prove the importance of learning a particular first aid skill.
4. ON-LINE SITES
U.S. Fire Administration has posted federal guidelines and other information resources about responding to bioterrorism incidents.
Find them at
Anthrax "fact sheet" provided by the U.S. Centers for Disease Control and Prevention located at
OSHA's Tips on Keeping Employees Safe in Cold Weather can be found at
5. FIRST AID DIGEST
Mild Hypothermia
Alton Thygerson
Serious health problems can result from prolonged cold exposure. The most common involves hypothermia. When you hear about hypothermia, most people usually think of someone stranded in a terrible winter storm. Hypothermia develops when a person gets so chilled that their body is unable to warm up. The chilling conditions of hypothermia set in when the body loses heat faster than it retains heat. Those in the outdoors for hours at a time are the most susceptible to hypothermia.
Contact with water can bring hypothermia on even faster because water cools your core body temperature 25 times faster. If you are drenched from rain, snow, submersed in water, or perspiring heavily, you will lose body heat faster than you would under dry conditions. Hypothermia is most likely at very cold temperatures, but can occur even at cool temperatures (above 40 F).
Hypothermic victims are most often (1) elderly people with inadequate food, clothing, or heating; (2) babies sleeping in cold bedrooms; (3) drug or alcohol abusers; and (4) people who remain outdoors for long periods--the homeless, hikers, hunters, cross-country skiers, snowmobilers.
If you are outside in cold conditions, try to dress appropriately. About half of your body heat escapes through you head, so wearing a hat can slow down that process. Wear a synthetic fabric next to the skin which draws moistures away from the skin. The next layer is insulation. The amount depends upon the temperature and your physical activity. Fleece fabrics are ideal. The outer clothing layer should be wind and water resistant and breathable. Protection for the hands is essential, and mittens are suggested. In addition to the mittens, wearing a pair of thin gloves under the mittens is recommended if you need to remove your hands from the mittens frequently.
Signs of Mild Hypothermia
Watch for the "umbles." Mildly hypothermic victims will stumble, mumble, fumble, and grumble.
Those with mild hypothermia will also have uncontrollable shivering.
Check the person¹s body temperature by placing a bare hand against the person¹s abdominal skin. If the skin feels warm, hypothermia is unlikely. This method does not provide a reliable estimate of the person¹s core temperature. Those with cold skin should have a low reading rectal thermometer measurement (household thermometers are not useful). Unless in a medical care facility, rectal measurements are not usually done because of the scarcity of a low-reading thermometer and the embarrassment by both victim and rescuers.
What to Do for Mild Hypothermia?
If you notice any of the above signs, obtain medical advice. If medical care is not immediately available, help by:
1. Getting the victim into a warm room or shelter.
2. If the victim has on any wet clothing, remove it.
3. Wrap the victim in dry blankets or clothing. Cover the head with a stocking cap if available.
4. Allow the victim to shiver. Most mildly hypothermic victims can rewarm themselves by shivering. Shivering generates heat. External methods to rewarm should not be used, especially on the extremities, because skin rewarming leads to vasodilatation (widens blood vessels), which can lead to a drop in blood pressure and a dangerous condition known as afterdrop. Rewarming the skin will stop shivering is the most effective way to rewarm a mildly hypothermic victim.
5. Do not give the victim alcohol. It interferes with shivering and accelerates heat loss by vasodilating the skin¹s blood vessels. The victim may feel warmer temporarily (flushed skin).
6. Do not give any cigarettes to smoke because the chemicals restrict blood flow.
7. Warm drinks taste good and may give a psychological boost, but they have no warming effect. Warm drinks signal the brain to send more blood to the skin which leads to some heat loss (flushing of skin). It would take more than the stomach could hold and at a temperature high enough to cause burns to be effective. If the victim can swallow, fluids are highly recommended because dehydration is usually present.
8. Do not rub or massage the skin since it will suppress shivering and will dilate the skin¹s blood vessels causing more heat loss. These procedures are not substitutes for proper medical care.
Hypothermia is a medical emergency and should be evaluated by a health care provider. Knowing what to do is an important part of protecting your health and the health of others.
6. WHAT'S NEW?
Just Published:
Critical Care Transport field guide
ISBN: 0-7637-1580-8
Jones and Bartlett Publishers is proud to announce the publication of a new field guide: Critical Care Transport, from Michael Czarnecki and the University of Maryland, Baltimore County (UMBC).
The Critical Care Transport field guide is part of the comprehensive EMS Field Guide series designed with the special needs of field practitioners like you in mind. Like all other field guides in the series, the Critical Care Transport field guide is pocket-sized, spiral bound, and water resistant.
This field guide was designed to be your resource for fast review in the field. It will help you recognize critical situations and improve on-site care of critical patients.
The Critical Care Transport field guide includes detailed information on:
- Lab panels, tests and values
- Electrocardiography
- Thrombolytic agents
- Blood administration
- Hemodynamic monitoring
- Swan-Ganz monitoring
- Intra-aortic balloon pumps
- Ventilators
- Rapid sequence intubation
- Chest tubes
- Critical care medications
- Burn management